Endometriosis and Infertility
The tissue lining a woman’s uterus is called the endometrium or endometrial tissue. Normally, this material develops, sheds and grows again during a woman’s menstrual cycle. However, sometimes the tissue grows outside of the uterus and attaches to other organs, such as the ovaries or fallopian tubes or elsewhere in the pelvic area and abdominal cavity. This condition is called endometriosis, and it is one of the common causes of infertility. According to the American Society for Reproductive Medicine, 30-50% of infertile women have endometriosis – but this doesn’t mean that every woman with endometriosis will necessarily have trouble conceiving.
What are the causes and symptoms of Edometriosis?
While there is no known specific cause of endometriosis, there are several theories for possible causes. According to one, endometrial cells somehow enter the general bloodstream and then circulate and attach to other body parts; another possibility is that endometrial tissue backs up in the fallopian tubes and then passes into the abdominal cavity and affixes to other organs.
Symptoms of endometriosis include severe lower abdominal and pelvic pain during menstrual periods and/or bowel movements, pain during or after sexual intercourse, abnormal menstrual flow and pain, spotting or bleeding between menstrual periods. If a health care provider suspects that a woman is suffering from endometriosis, the condition can be diagnosed by a laparoscopic examination.
Endometriosis can impact fertility in a number of different ways. It is a progressive disease, and its damaging effects can become more severe over time. For this reason, women suffering from endometriosis who wish to become pregnant are encouraged not to put off efforts to conceive. When a woman is diagnosed with endometriosis, the amount and location of the disease determines whether it’s considered minimal, mild, moderate or severe. In more severe cases, scar tissue from endometriosis adheres to the ovaries or fallopian tubes, and egg release may be restricted or blocked, making fertilization difficult or impossible. Blood-filled cysts called endometriomas can develop and compress the ovaries, which can damage egg supply or inhibit ovulation. Women with endometriosis may also produce cells that attack and potentially destroy sperm. Additionally, endometriosis has been linked to an overproduction of prostaglandins, which can interfere with normal reproductive processes. Unsustainable ectopic pregnancies, where a fertilized egg doesn’t move from the fallopian tube to the uterus, are more common in women with endometriosis. And if a woman with endometriosis experiences pain during intercourse, she may be inclined to have sex less frequently, limiting the possibility of her getting pregnant.
Treatment Choices for Endometriosis and Infertility
Laparoscopic surgery (sometimes performed at the same time as diagnosis) can repair some existing damage from endometriosis and remove small lesions, scar tissue and endometriomas. This may help with both pain and infertility, in terms of opening up blockages in the ovaries and fallopian tubes. However, there is no guarantee that surgery will “cure” infertility problems. Endometrial lesions often recur, and in cases of severe endometriosis pregnancy rates often remain low after surgery. Also, removal of tissue around the ovaries might compromise ovarian tissue as well, which could jeopardize healthy egg production. If no other infertility factors are present, women with mild to moderate endometriosis might respond positively to assisted reproductive procedures such as gamete intrafallopian transfer (GIFT) or controlled ovarian hyperstimulation (using medication to cause development of multiple eggs in one cycle) combined with intrauterine insemination (injecting sperm into the uterus via a catheter). Women suffering from endometriosis who have blocked fallopian tubes or those over the age of 35 who’ve been treated surgically but still haven’t gotten pregnant might benefit from in vitro fertilization (IVF) treatment, especially if they’re still producing viable eggs.